| NPI | 1174091938 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: FL ME163922) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME163922) |
| 208000000X Pediatrics (Licence: NY 314151) | |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2025-10-24 |